Employment Application Form

Moonlight Horticultural - Application for Employment

If you have a RESUME, upload it here:

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Name:*

First NameMiddle NameLast Name

Salary Expectations

Hourly Rate

Phone Number:*

Area CodePhone Number

E-mail Address:*

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Birth Date - Must be 18 or older (This information will be used only for child labor law purposes)*

MonthDayYear

Are there any days, shifts, or hours you will not work?*

YesNo

If yes, please explain

explanation

Will you work overtime, if required?*

YesNo

When will you be able to start work?*

Date

How did you learn about our company?*

If referral, who were you referred by?

First NameLast Name

Have you ever applied or worked at our Company before?*

YesNo

If yes, provide dates:

MM/DD/YYYY - MM/DD/YYYY

Are you legally authorized to work in the United States?*

YesNo

Will you now or in the future require sponsorship for employment visa status (e.g.,H-1B visa status)?*

YesNo

DRIVING RECORD

Do you have a valid driver's license?*

YesNo

Have you had any tickets?*

YesNo

If yes, please explain.

Upload your Department of Motor Vehicles Abstract of Driving Record:

Upload a File

DMV Abstract of Driving Record is to be supplied at applicant's own expense.

Please note, that upon hire, Moonlight will obtain your authorization to enroll you in LENS (NYSDMV License Event Notification Service) so that it can track your driving record while employed by Moonlight.

EDUCATION

Describe any educational degrees, skills, training or experience you believe are relevant to the job applied for:

	Name, City, and State of Educational Institution	Graduated, yes or no	If no, Degree credits earned	Type of degree received or expected	Major	Minor	Grade Point / Overall GPA
High School
College or University
Technical / GED
Licenses / Certification / Other

Employment History:

Please complete for all full-time or part-time employment beginning with most recent employer. You may include as part of your employment history any verified work performed on a volunteer basis. All applicants should start with their most recent job, include active military assignments and voluntary employment and provide 10 years of history. You must explain any gaps in your employment history.

Company Name / Address

Phone Number

Area CodePhone Number

Name of Supervisor

First NameLast Name

May we contact Supervisor:

YesNo

Dates Employed: example (02/11/12 - 5/23/18)

State job titles and describe job duties:

Reasons for leaving:

Company Name / Address

Phone Number

Area CodePhone Number

Name of Supervisor

First NameLast Name

May we contact Supervisor:

YesNo

Dates Employed: example (02/11/12 - 5/23/18)

State job titles and describe job duties:

Reasons for leaving:

Company Name / Address

Phone Number

Area CodePhone Number

Name of Supervisor

First NameLast Name

May we contact Supervisor:

YesNo

Dates Employed: example (02/11/12 - 5/23/18)

State job titles and describe job duties:

Reasons for leaving:

Please explain any gaps in your employment history:

Have you ever been discharged or forced to resign?*

YesNo

If yes, please explain:

Did you receive any discipline in your last 12 months of active employment?*

YesNo

If yes, please explain:

Were you given a performance evaluation within the last 12 mths of active employment?*

YesNo

If yes, what was your score and score range?

Have you signed any non-competition or non-solicitation agreement with any other employer that might restrict you from working for this company (you may be required tofurnish a copy of the agreement)?*

YesNo

If yes, please explain:

REFERENCES (Please list three people not related to you who know your qualifications.)*

	Name	Address	Phone	Relationship
Reference #1
Reference #2
Reference #3

MILITARY (Complete only if you served in the military.)

Branch of Service:

Number of Years /Months of Service:

Rank at Discharge:

Date of Discharge:

Date

Reason for Leaving:

Describe any military skills, training or experience you believe are relevant to the job you applied for:

Signature:*

Date:*